NCHS Dataline

A recent report from the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention examines the prevalence of low levels of high-density lipoprotein cholesterol among adults by physical activity. Another new NCHS report looks at barriers to health care among those with multiple chronic conditions. Finally, a report on ambulatory surgery in hospitals and ambulatory surgery centers provides the latest data on ambulatory surgery by patient characteristics and number and types of procedures performed.

Low High-Density Lipoprotein Cholesterol and Physical Activity

Regular physical activity can improve cholesterol levels among adults, including raising the levels of high-density lipoprotein (HDL) cholesterol (ie, the “good” cholesterol). HDL cholesterol is defined as serum HDL cholesterol <40 mg/dL based on laboratory measurement. The 2008 Physical Activity Guidelines for Americans ¹ recommends that adults engage in ≥150 minutes of moderate-intensity aerobic activity per week, 75 minutes of vigorous-intensity aerobic activity per week, or an equivalent combination, which could lead to a decreased prevalence of low HDL cholesterol levels.

A new NCHS report, “Prevalence of Low High-Density Lipoprotein Cholesterol Among Adults, by Physical Activity: United States, 2011-2014,” ² presents national data on the prevalence of low HDL cholesterol among US adults aged ≥20 by whether they met the 2008 Physical Activity Guidelines. Data for the report were from the National Health and Nutrition Examination Survey, a large-scale nationwide probability survey of a sample of the civilian, noninstitutionalized population, which collects data through health interviews, standardized health examinations, and laboratory testing.

The report shows that during 2011-2014, the prevalence of low HDL cholesterol was 19.0% among all adults, and that prevalence was higher among adults who did not meet the Physical Activity Guidelines (21.0%) than among those who did (17.7%). For men, the prevalence of low HDL cholesterol was 35.4% for those who did not meet the guidelines and 25.0% for those who did; for women, the prevalence was 11.8% for those who did not meet the guidelines and 9.1% for those who did.

The prevalence of low HDL cholesterol declined with increasing age, regardless of physical activity status. For adults aged ≥60, those who did not meet the Physical Activity Guidelines had a higher prevalence of low HDL cholesterol (18.1%) than those who met the guidelines (12.6%), but the difference in the prevalence of low HDL cholesterol by physical activity status among adults aged 20 to 39 and 40 to 59 was not significant. The report noted significant differences by race/ethnicity. Among non-Hispanic white and non-Hispanic black adults, the prevalence of low HDL cholesterol was higher among those who did not meet the Physical Activity Guidelines than among those who did (21.8% vs 18.1% for non-Hispanic white adults and 16.2% vs 12.4% for non-Hispanic black adults). No significant differences in the prevalence of low HDL cholesterol by physical activity status were found among non-Hispanic Asian and Hispanic adults. Among adults who met the Physical Activity Guidelines, the prevalence of low HDL cholesterol was higher among Hispanic adults (20.7%) than among non-Hispanic black (12.4%) and non-Hispanic Asian (14.4%) adults.

The report also noted differences by education level. College graduates who did not meet the Physical Activity Guidelines had a higher prevalence of low HDL cholesterol (16.8%) than college graduates who met the guidelines (12.3%), but no significant differences were found in low HDL cholesterol prevalence by physical activity status among adults with other education levels. Among those who met the Physical Activity Guidelines, adults with higher education levels had a lower prevalence of low HDL cholesterol: 21.7% for adults with ≤high school education, 19.2% for adults with some college education, and 12.3% for college graduates. A similar pattern was observed among adults who did not meet the Physical Activity Guidelines (23.6% for adults with ≤high school education, 21.0% for those with some college education, and 16.8% for college graduates).

Barriers to Health Care Among Adults With Multiple Chronic Conditions

According to the National Health Interview Survey (NHIS), in 2014, 25.7% of adults aged ≥18 had been diagnosed with multiple chronic conditions, which NCHS defines as having ≥2 of the following 10 selected chronic conditions: hypertension, cancer, stroke, coronary heart disease, diabetes, arthritis, hepatitis, current asthma, weak or failing kidneys, and chronic obstructive pulmonary disease. ³

A new report, “Barriers to Health Care for Adults With Multiple Chronic Conditions: United States, 2012-2015,” ⁴ presents data from the NHIS, a large-scale household interview survey, and examines health care access and use among adults with multiple chronic conditions compared with those who had 1 or no diagnosed chronic conditions. The report found that adults with multiple chronic conditions faced increased barriers of cost or noncost factors, such as availability and transportation, in accessing health care services. The percentage of adults aged 18 to 64 who delayed or did not obtain needed medical care in the past 12 months because of cost was lowest among those without a chronic condition (8.5%) and highest among those with ≥2 chronic conditions (16.9%). Among adults aged ≥65, those with ≥2 chronic conditions were more likely to have delayed or not obtained needed medical care in the past 12 months because of cost (5.2%) than adults without a chronic condition (2.7%) and those with 1 chronic condition (2.9%).

Factors other than cost also presented barriers to obtaining health care. Respondents to the NHIS were asked, “Have you delayed getting care for any of the following reasons in the past 12 months?” Reasons included being unable to get through on the telephone, being unable to get an appointment soon enough, having to wait too long to see the doctor after arriving, the clinic or doctor’s office not being open when the adult was able to get there, or not having transportation. For adults aged 18 to 64, 7.9% of those without a chronic condition compared with 19.7% of those with ≥2 chronic conditions delayed needed medical care in the past 12 months because of 1 of these noncost reasons. The percentage of adults aged ≥65 who delayed needed medical care in the past 12 months because of a noncost reason was lowest among those without a chronic condition (3.4%) and highest among those with ≥2 chronic conditions (11.4%).

Ambulatory Surgery in the United States

A new report from NCHS, “Ambulatory Surgery Data From Hospitals and Ambulatory Surgery Centers: United States, 2010,” ⁵ presents nationally representative estimates of ambulatory surgery performed in hospitals and ambulatory surgery centers (ASCs) from the 2010 National Hospital Ambulatory Medical Care Survey. Ambulatory surgery is defined as the surgical and nonsurgical procedures that are nonemergency, scheduled in advance, and generally do not result in an overnight hospital stay. Data are shown by patient characteristics (eg, age, sex, expected payment source, duration of surgery, discharge disposition) and the number and types of procedures performed in these settings.

In 2010, 48.3 million surgical and nonsurgical procedures were performed during 28.6 million ambulatory surgery visits to hospitals and ASCs combined. For both males and females, 39% of procedures were performed on those aged 45 to 64. By sex and age, more procedures were performed on females aged 15 to 44 (24%) than on males aged 15 to 44 (18%), but fewer procedures were performed on females aged <15 (4%) than on males aged <15 (9%). About 19% of procedures were performed on adults aged 65 to 74, and about 14% of procedures were performed on adults aged ≥75.

The principal expected source of payment for ambulatory surgery visits was most often listed as private insurance (51%), followed by Medicare (31%) and Medicaid (8%). The most frequently performed ambulatory surgery procedures were endoscopy of the large intestine (4.0 million), endoscopy of the small intestine (2.2 million), extraction of lens (2.9 million), insertion of prosthetic lens (2.6 million), and injection of agent into the spinal canal (2.9 million). Only 2% of patient visits were admitted to the hospital as inpatients after ambulatory surgery.

Sandra S. Smith, MPH Communications Consultant at the National Center for Health Statistics